Tag Archives: privacy

I’ve asked the ICO to assess whether the sale of millions of health records to insurance companies so that they could “refine” their premiums was compliant with the law

I’m about to disclose some sensitive personal data: I have been to hospital a few times over recent years…along with 47 million other people, whose records from these visits, according to reports in the media, were sold to an actuarial society for insurance premium purposes. The Telegraph reports

a report by a major UK insurance society discloses that it was able to obtain 13 years of hospital data – covering 47 million patients – in order to help companies “refine” their premiums.

As a result they recommended an increase in the costs of policies for thousands of customers last year. The report by the Staple Inn Actuarial Society – a major organisation for UK insurers – details how it was able to use NHS data covering all hospital in-patient stays between 1997 and 2010 to track the medical histories of patients, identified by date of birth and postcode.

I don’t know if this use of my sensitive personal data (if it was indeed my personal data) was in compliance with the Data Protection Act 1998 (DPA), although sadly I suspect that it was, but section 42 of the DPA allows a data subject to request the Information Commissioner to make an assessment as to whether it is likely or unlikely that the processing has been or is being carried out in compliance with the provisions of the DPA. So that’s what I’ve done:

Hi

As a data subject with a number of hospital episodes over recent years I am disturbed to hear that the Hospital Episode Statistics (HES) of potentially 47 million patients were disclosed to Staple Inn Actuarial Society (SIAS), apparently for the purposes of helping insurance companies “refine” their premiums. I became aware of this through reports in the media (e.g. http://www.telegraph.co.uk/health/healthnews/10656893/Hospital-records-of-all-NHS-patients-sold-to-insurers.html). I am asking, pursuant to my right under section 42 of the Data Protection Act 1998, the ICO to assess whether various parts of this process were in compliance with the relevant data controllers’ obligations under the DPA:

1) I was not aware, until relatively recently, that HESs were provided to the HSCIC – was this disclosure by hospitals compliant with their DPA obligations?

2) Was the general processing (e.g. retention, manipulation, anonymisation, pseudonymisation) of this personal data compliant with HSCIC’s or, to the extent that HSCIC is a data processor to NHS England’s data controller, NHS England’s DPA obligations?

3) Was the disclosure of what appears to have been sensitive personal data (I note the broad definition of “personal data”, and your own guidance on anonymisation) to SIAS compliant with HSCIC’s (or NHS England’s) DPA obligations

4) Was SIAS’s subsequent processing of this sensitive personal data compliant with its DPA obligations?

You will appreciate that I do not have access to some information, so it may be that when I refer to HSCIC or NHS England or SIAS I should refer to predecessor organisations.

Please let me know if you need any further information to make this assessment.

with best wishes, Jon Baines

We’ve been told on a number of occasions recently that we shouldn’t be worried about our GP records being uploaded to HSCIC under the care.data initiative, because our hospital records have been used in this way for so long. Clare Gerada, former Chair of the Council of the Royal College of General Practitioners wrote in the BMJ that

for 25 years, hospital data have been handled securely with a suite of legal safeguards to protect confidentiality—the exact same safeguards that will continue to be applied when primary care data are added

Well, it seems to me that those legal safeguards might have failed to prevent (indeed, might have actively permitted) a breach involving 47 million records. I’m very interested to know what the Information Commissioner’s assessment will be.

UPDATE: 24 February 2014

An ICO spokesperson later said:

“We’re aware of this story, and will be gathering more information – specifically around whether the information had been anonymised – before deciding what action to take.”

The HSCIC believes greater scrutiny should have been applied by our predecessor body prior to an instance where data was shared with an actuarial society

UPDATE: 27 February 2014

GP and Clinical Lecturer Anne Marie Cunningham has an excellent post on what types of data were apparently disclosed by NHSIC (or HSCIC), and subsequently processed by, or on behalf, of SIAS. I would recommend reading the comments as well. It does seems to me that we may still be talking about pseudonymised personal data, which would mean that the relevant data controllers still had obligations under the DPA, and the ICO would have jurisdiction to investigate, and, if necessary, take regulatory action.

The ICO has kindly acknowledged receipt of my request for assessment, saying it has been passed to their health sector team for “further detailed consideration”.

UPDATE: 24 May 2014

Er, there is no real update. There was a slight hiccup, when the ICO told me it was not making an assessment because “[it] is already aware of this issue and is investigating them accordingly. Given that we do not necessarily require individual complaints to take consider taking further action your case is closed”. After I queried the legal basis for failing to make a section 42 assessment as requested, the position was “clarified”:

…we will make an assessment in relation to this case, however we are unable to do so at this present time…This is because the office is currently investigating whether, as alleged in the media, actual personal data has been shared by the HSCIC to various other organisations including Staple Inn, PA consulting and Google

I don’t criticise the ICO for taking its time to investigate: it involves a complicated assessment of whether the data disclosed was personal data. In a piece I wrote recently for the Society of Computers and Law I described the question of whether data is anonymous or not as a “profound debate”. And it is also highly complex. But what this delay, in assessing just one aspect of health data disclosure, does show, is that the arbitrary six-month delay to the implementation of care.data was never going to be sufficient to deal with all the issues, and sufficiently assure the public, and medical practitioners, to enable it to proceed. A vote on 23 May by the BMA’s Local Medical Committee’s conference emphatically illustrates this.

I am worried that even the most robust and secure data security measures can fail, or be overridden. Patients’ identifiable data could be compromised.

I am worried that there is a limit to how much users of the data could be restrained from making secondary, not-beneficial-to-patients, usage of data to which they are given access (Geraint Lewis, NHS Chief Data officer, was asked how, for instance, insurance companies would be prevented from doing this – he pointed to the Information Commissioner’s powers to impose Monetary Penalty Notices to a maximum of £500,000 for suitably serious contraventions of the Data Protection Act 1998. But a penalty for misuse of data will only be a net penalty if it outstrips profit from the usage.)

I am worried that some people will avoid seeking medical treatment, particularly for sensitive or serious ailments, if they in turn worry about who might have access to their data.

I am, in more general terms, worried about the lack of transparency that has surrounded the programme, and the lack of clear information. I am worried that, if the risks are so low and the benefits so high, why were initial attempts made to sneak this under the public’s radar?

I am worried that the amassing of and use of personal data in itself carries risks.

I am worried that I am wrong about all this, and that I am attacking a programme which will potentially deliver personal and societal benefits.

But, ultimately, I am not sure it is for me to say specifically what I am worried will happen. I don’t know specifically what will happen with a lot of things I worry about.

Surely it is for the proponents of care.data to say why I should be reassured. And I’m not.

Last week, after months of (over)thinking about it, I sent my GP a letter, based on the excellent template by the tireless MedConfidential refusing consent for identifiable data from my electronic medical records to be transferred to the Health and Social Care Information Centre (HSCIC).

I won’t rehearse the eloquent arguments against the current care.data proposals that you can read on MedConfidential’s site, and elsewhere (for instance GP Neil Bhatia’s excellent site). Nor will I rehearse arguments in favour. I have written about the subject in the past, and I don’t want to add to the general clamour. What I do want to say is why I have opted-out:

I’ve been struck by the inaccuracy and disingenuousness of the information which is being given to us in support of care.data. We are told, for instance, that “Your date of birth, full postcode, NHS Number and gender rather than your name will be used to link your records in a secure system, managed by the HSCIC. Once this information has been linked, a new record will be created. This new record will not contain information that identifies you”. This is cleverly worded: it does not say (because it would not be true) that this data will be anonymised, but it certainly tries to give that impression.

I have, ever since I first became aware of this issue, noted that there has been a lack of openness on the part of proponents. This has manifested itself in many ways, and people should be aware that the current leafleting campaign (as flawed as it is – note that it is not personally addressed to individuals, but simply sent to households, and doesn’t contain a form enabling people to opt-out) would not have come about were it not for concerns raised about this lack of openness.

I’ve noted the emotive campaign launched by leading charities in support of the campaign. But I’ve also noted the response by MedConfidential which highlights that the charities’ campaign doesn’t draw attention to secondary usage of the information gathered, which could potentially be by pharmaceutical and other commerical companies, universities and other academic organisations, information intermediaries and think-tanks. On a general level, I do not think that amassing of personal data can ever be without potential risks and drawbacks, some of which include – the risk of breaches of data security, the risk of people failing to seek medical advice because of privacy fears, commercial use – and none of which are addressed in the charities’ campaign.

Finally, and, for me, crucially, if I fail to opt-out now, I’ve lost my chance – my data once uploaded cannot be deleted. However, opting out now does not preclude opting in in future. So, should I subsequently become convinced that societal and individual benefits from this amassing of electronic personal data outweigh my strong concerns about privacy and consent, I can change my mind in a way I couldn’t if I failed to opt out now.